Medicare and Prescription Drug
Costs-Medicare and Medicaid Spending-Part IIa of a
VII Part Series

(6/1/17)- An analysis of government data by the Wall Street Journal
concluded that the median out of pocket cost for
drugs purchased through Part D of Medicare was $117 in 2015, in inflation
adjusted dollars, up from $79 in 2011.

The analysis excluded low income individuals whose co-pays were paid for
primarily by the government. There were 220 drugs in 2015 that had annual
out-of-pocket costs of $1,000 or more, up from 118 drugs in 2011

(2/17/17)- Health-care spending increased 4.8% in 2016, reaching about $3.4
trillion in total, according to a report from the Centers for Medicare and
Medicaid Services (CMS). This was down from the 5.8% level, as we pointed out
in our item dated 12/5/16 below. The report was published in a recent edition
of Health Affairs.

Health-care spending accounted for 17.8% of the gross domestic product (GDP)
in 2015 and is expected to reach 19.9% by 2025.

Prescription drug spending grew by 5% in 2016, compared with 9% in 2015,
with a large part of the decrease attributed to the drop in the cost for the
hepatitis drug.

(12/5/16)- National health spending grew at a rate of 5.8% in 2015, which is
at a slightly higher rate than the Centers for Medicare and Medicaid Services
(CMS) had projected in June. Health spending accounted for 17.8% of the
national gross domestic product in 2015, up from 17.4% in 2014.

These findings were published in a recent edition of the journal Health
Affairs. Spending on physicians and clinical services grew at a rate of 6.3%,
which is in far excess of the rate of inflation at under
2%.

With the premiums for health insurance increasing in the marketplace for
coverage under the Affordable Care Act, these numbers are expected to grow at
an even greater percentage than the increase in 2015.

(11/16/16)- Medicare recently released updated figure to its online database
at “Medicare Drug Spending Dashboard” that displays the rising costs for both
individual and cumulative totals for both branded and generic drugs to the
agency.

Total spending for Medicare for drugs rose 26% to $1.8 billion. Many of the
drugs with the greatest price increases were generic drugs. The site was
launched in December of last year, and it will be periodically updated.

The costliest drug to Medicare last year was the hepatitis C medication Harvoni, made by Gilead Sciences Inc., which cost $7.03 in
total spending, followed by Sanofi SA’s diabetes drug Lantus, which cost $4.4
billion to the agency.

(8/27/16)- Health-care spending reached 18.2% of the gross domestic product
(GDP) as of June, up from 13.3% in 2000, according to the-Altarum
Institute, a health research firm.

A study from the Brookings Institute concluded that households now devote
the largest share of their spending to health-care, 8.9%, a rise of over 3%
from 1984 to 2014.

Both presidential candidates are talking about reducing medical expenses,
but that certainly won’t be the case when the new premiums for health-insurance
premiums will be announced over the coming weeks for those enrolling in the
marketplace beginning in November for insurance under the Affordable Care Act.

(7/19/16)- Actuaries at the Centers for Medicare and Medicaid Services (CMS)
estimated in their latest report that health care spending grew at a 5.5% pace
in 2015, to a total of $3.2 trillion, compared to a 5.3%rise in 2014. Their
report, was published in a recent edition of the journal Health Affairs

The report went om to estimate that health care
spending will dip to 4.8% in 2016. For the five years from 2009 through 2013
that spending stayed lower than 4% for those consecutive years.

The actuaries also predicted a continued decline in the percentage of
uninsured from 11% in 2014 to 8% by 2025. That decline is largely attributable
to the expanded Medicaid programs adopted in at last count by 38 states.

National spending will average over $10,000 this year, according to Obama
officials. Medicare spent about $12,000 per beneficiary in 2015.

Sean P. Kagan, an economist at the CMS was the lead author of the report

(3/11/16)- A recent edition of the Wall Street Journal contained a chart
that showed “the five drugs with the highest total expenditures under the
Medicare program for medications given in doctors
offices and outpatient settings.” They are

·Rituximab/Rituxan for
rheumatoid arthritis and cancer, with total Medicare payments in 2015 of $1.51
billion

·Ranibizumab/Lucentis for macular degeneration, with total Medicare
payments in 2015 of $1.37 billion

·Infiximab/Remicade for rheumatoid arthritis with total Medicare
payments in 2015 of $1.11 billion

·Pegfilgrastim/Neulasta for cancer with total Medicare payments in 2015 of
$1.10 billion

·Afibercept?Eyea
for macular degeneration with total Medicare payments in 2015 of $1.09 billion.

(12/27/15)- The Centers for Medicare and Medicaid Services (CMS) identified
at least 5 drugs that had increases of 100% in cost-per-unit from 2013 to 2014,
which were covered under Part D of Medicare. Vimova,
a pain-reliever saw a 500% increase after Horizon Pharma PLC purchased rights
to the drug from AstraZeneca.

In addition to Vimova, other drugs with big price
increases in cost-per-unit included Captopril and Digoxin, both used for
cardiovascular conditions.

The 2014 drug price information was part of a new online database, the
“Medicare Drug Spending Dashboard” detailing 80 drugs that ranked the highest
by total Medicare spending per member, or by the percentage increase. These
drugs accounted for 33% of all Medicare part D spending, and 71% of all
spending on prescriptions by Medicare Part B, which covers drugs administered
in a doctor’s office or outpatient clinic.

Medicare spending on prescription drugs rose 16.9% in 2014, versus 9.9% in
2013, according to the CMS.

About 540 drugs covered by Medicare Part D had increases in cost-per-unit of
at least 25% during 2014, according to the CMS.

Medicare Part B had 96 drugs with increases in cost-per-unit of at least 10%
in 2014.

(12/4/15)- Spending on all health care increased by 5.3% in 2014, according
to actuaries at the Centers for Medicare and Medicaid Services. That compares
with the 2.9% growth in 2013, which was the lowest rate since the government
began tracking that data 55 years ago..

The report was published in a recent edition of the journal Health Affairs.
For the prior 5 years, average spending growth was less than 4%.

Enrollment in Medicaid grew by 7.7 million last year, largely because of
expanded Medicaid programs adopted by some states under the terms of the
Affordable Care Act. Federal health-care expenditures grew 11.7%, or 8.2
percentage points faster than in 2013.

(6/14/15)- Spending on health care in the U.S. fell 0.4% in the first
quarter of this year, compared to a 4.2% gain in the prior period, according to
the latest government statistics. The U.S. economy contracted by 0.7% in the
first three months of the year, but this data is expected to be revised upward
in the coming months

Although spending on health care and social assistance declined, outlays at
hospitals rose 2.5% in the first quarter compared to a 4.3% pace in the prior
period.

Over the past year health-care spending has risen at an unadjusted rate of
7.2%.

Drug spending grew by 13.8% for Medicare plans in 2014, over 2013, while it
rose 13.1% for commercial plans, and 10.29% for Medicaid plans, according to
the latest annual survey from Express Script Holdings Co., the largest
prescription benefits manager with 85 million participants.

(9/8/14)- Medicare will spend about $11,200 on average for every person
enrolled in the program, with that cost falling to $11,000 by 2017, according
to the latest estimate from the Congressional Budget Office (CBO). The CBO
estimate called for that number to stay below $11,000 until 2020.

This is the first time since the late 1990s when Congress made some cuts in
Medicare spending that the growth did not continue from year to year. The drop
in spending went on for three years back then, but this fall is expected to
occur over the longest period of time in Medicare history.

The two main factors behind this startling drop are the “young baby boomers”
who are therefore healthier, who are now entering the system, and secondly,
Medicare patients have been using fewer expensive medical services and the
increased usage of generic drugs instead of brand name medications.

Reductions in spending made in the last four years alone have resulted in a
10-year savings of more than $715 billion for Medicare. The CBO’s projection
assumes that Congress will not raise doctors’ pay as it has done every year
through the “doc fix”, but even if it does act, the trend would still continue
next year.

(7/17/14)- The nonpartisan Congressional Budget Office (CBO) said in its
annual 25-year forecast that federal spending on major health-care programs
would amount to 8% of the gross-domestic product by 2039, one-tenth of a
percentage point less than its previous projection

The CBO’s estimate for spending by Medicare, Medicaid and other health
programs has been reduced by $1.23 trillion, since 2010, the year the
Affordable Care Act was passed. By 2039, the savings would amount to $250
billion a year.

“Evidence suggests that hospitals and other providers may be able to achieve
significant productivity gains or to restrain the growth of their costs in some
other way,” according to the report.

(1/14)- A recent report issued by the Centers for Medicare and Medicaid
Services indicated that health-care costs continued to grow slowly for the
fourth year in a row. Health-care spending in 2012 increased by 3.7% over 2011
to $2.8 trillion, and that amounts is about 17.2% of the gross domestic
spending, down from 17.3% in 2011. That comes to about $8,900 per person.

Spending on hospital care and home-health services grew the most, rising by
4.9% to $882 billion in 2012, versus the 3.5% increase in 2011. Drug costs grew
only0.4%in 2012, versus the 2.5% the year before. Doctors’ services and
outpatient clinics costs grew by 4.6%, to $565 billion in 2012. Prescription
drug costs grew by only 0.04 to $263 billion, compared to the increase of 2.5%
the year before.

(12/7/13)- The Congressional Budget Office now estimates that Medicare
spending in 2020 will be $137 billion lower than it thought in 2010, a drop of
15%. Medicaid spending will be $85 billion or 16% lower. The CBO further
estimates that private health insurance premiums are expected to be about 9%
lower than it thought in 2010.

(11/21/13)- Researchers
reporting in the Journal of the American Medical Association noted that 91% of
the rise in U.S. health care spending was attributed to annual increases in the
prices of drugs, devices and hospital care, not a growing population of elderly
patients. The study also showed that chronic conditions in patients younger
than 65 were responsible for two-thirds of total U.S. health care spending.

(10/17/13)-New estimates from the Office of the Actuary at the Centers
for Medicare and Medicaid Services project that aggregate health care spending
in the United States will grow at an average annual rate of 5.8 percent for
2012-22, or 1.0 percentage point faster than the expected growth in the Gross
Domestic Product.

(9/22/13)- According to data released by the Commerce Department, the cost
for medical care in July rose just 1% from a year earlier. This has been the
slowest annual rate of growth since the early 1960s. Health-care increases now
trail overall inflation, which itself has been historically slow in recent
years.

(7/16/13)- A report from the Kaiser Family Foundation estimated that 10,000
baby boomers turn 65 every day. Per capita health costs at that age and older
are $9,744 a year, compared with $2,739 for those 25 to 44.

Spending on prescription drugs dropped 1% in 2012 to $325.8 billion, the
first decline since 1957, according to IMS Institute for Healthcare Information

(2/13/13)- The latest projections from the Congressional Budget Office (CBO)
estimated that spending on Medicare and Medicaid will be about $200 billion, or 15% less than it had projected three years ago.
The latest data also shows that health care spending growth is at the lowest
rate in decades for a fourth consecutive year.

From 2009 to 2011, total health spending grew at the lowest annual rate
since the government began keeping such records 52 years ago. In fiscal year
2012, Medicare spending per beneficiary grew just 0.4%. Data from the CBO
showed that Medicare spending grew just 4% in 2012

(9/28/12)-After several years of patients delaying or forgoing medical care,
utilization of health insurance is increasing, data indicate. A report from an investment
analyst showed physician visit volume in the second quarter of 2012 increased
4.8%, ending two years of mostly declining rates.

The trend continues wherein corporate America is giving lump sum payments to
their retirees and having them enroll in Medicare while removing them from
their benefits coverage under the companies health
care insurance plans.

Medicare's financial problem will only grow worse as more of corporate
America goes this route.

(7/10/12)- Medicare's net spending last year totaled $486 billion, which
represents 13.5% of all federal spending, according to the Congressional Budget
Office. The CBO estimated that Medicare spending would grow an average of 5.7%
per year through 2022 and equal 16.2% of all federal expenditures by then.

In 2009, 6.6% if the people who received hospital care died. Those 1.6
million individuals accounted for 22.3% of total hospital spending, according
to an analysis that was done by the Wall St. Journal.

In 2009, the top 10% of Medicare beneficiaries who received hospital care
accounted for 64% of the program's spending.

(1/17/12)- As our item dated 8/1/11 below stated, health care spending rose
only 3.9% in 2010, which breaks down to $8,402 per person, according to the
Centers for Medicare and Medicaid Services. Health care spending rose 3.8% in
2009.

Medicare spending for older Americans and the disabled grew by 5% in 2010
from 2009, which was the smallest increase in a decade. The main reason for
this smaller increase was a slowdown in spending for the Medicare Advantage
program. Medicare spending had grown by over 7% in 2009 form 2008

Federal health spending grew to $743 billion in 2010, up from $530 billion
in 2007.

The study for 2010 said that hospitals reported a decline in admissions and
slower growth in emergency room visits and outpatient visits. Doctor's office
visits also declined and spending for doctors' services grew just 1.8% to $416
billion in 2010

Growth in spending on private insurance slowed to 2.5%, as fewer people
enrolled in plans or shifted to plans with cheaper premiums and/or higher
out-of-pocket costs. Spending out-of-pocket increased by 1.8%

(8/1/11)- Spending by federal, state and local governments is expected to
account for 49% of all health spending, of $2.28 trillion, in 2020, up from 45%
in 2010 according to a report from the federal Centers for Medicare and
Medicaid Services that was recently published in the journal Health Affairs.

Private businesses are expected to account for 18% of all health spending,
or $820.5 billion, down from 20% in 2010.

The data from the report showed that national health spending grew 3.9% to a
total of $2.6 trillion in 2010.

(4/5/11)- Drug manufacturers have price caps on the price that they can
charge for their products being sold to medical facilities that provide
safety-net health services, including Medicaid patients. These caps are set in
agreements signed by the drug manufacturers and the federal government.

In a recent ruling from the Supreme Court in the case of Astra USA v. County
of Santa Clara, the court concluded that the county can not
bring the suit for overcharges, but rather that it is the responsibility of the
U.S. Department of Health and Human Services to bring such a court action.

(1/10/11)- A report from the office of the actuary at the Centers for
Medicare and Medicaid Services showed that total national health spending grew
by 4% in 2009, the slowest rate of increase in 50 years. The nation spent $2.5
trillion on health care in 2009, for an average of $8,086 a person.

Medicare spending reached $502 billion in 2009 out of that $2.5 billion,
according to the report. Medicare spending rose 7.9% in 2009, the same rate of
increase as in 2008, while enrollment grew about 2%.

Medicare spending increased an average of 2.3% for each person in a private
Medicare Advantage plan, and 6.9% for each person in the traditional program.
It still is about 11% more expensive for the government for people in Medicare
Advantage plans than it is to the government for people in the traditional
program.

"Many consumers decreased their use of health care goods and services,
partly because they had lost employer-based private health insurance coverage
and partly because their household income had declined," said Anne B.
Martin, an economist and principal author of the report that was recently
published in the journal Health Affairs.

Offsetting the slowdown in private health spending was a rapid increase in
Medicaid spending, partly as a result of an additional 3.5 million people
joining that program in 2009.

"Federal Medicaid spending increased 22% in 2009, the highest rate of
growth since 1991," said Ms. Martin said, while "
state spending decreased 9.8%, the largest decline in the program's
history."

Spending on health care by private insurance companies grew by 1.3% in 2009,
with the number of people covered by private insurance declining by 3.2% or 6.3
million.

Retail prescription drug spending rose to about $250 billion in 2009.
Out-of-pocket spending by consumers, including deductibles, co-payments and
purchases of goods and services not covered by insurance totaled almost $300
billion according to the report.

The share of the economy devoted to health care rose 1% in 2009, the largest
one-year increase in half-century of record keeping.

(9/20/10)- The number of Americans without health insurance rose by 4.4
million to 50.7 million last year, the largest annual jump since the government
began collecting comparable data in 1987, according to figures from the U.S.
Census Bureau.

The percentage of Americans covered by private insurance in 2009, 63.9%, was
the lowest since 1987,while the percentage of people
covered by government programs, 30.6%, was the highest. The number of American
with some form of health insurance dropped last year for the first time since
1987 to 253.6 million in 209 from 255.1 million in 2008.

The 50.7 million Americans who are uninsured is
16.7% of the population. The number of Americans with employer-sponsored
coverage dropped by 6.6 million to 169.7 million last year from 176.3 million
in 2008- the largest one time drop since 1987.

The total number of Americans with private insurance fell to 194.5 million
from 201 million. The number of Americans covered by Medicaid increased to 47.8
million in 2009 from 42.6 million in 2008, and is now the largest percentage of
the population on the program since 1987.

(3/23/10)- According to the latest figures from the non-partisan
Congressional Budget Office (CBO), the latest version of the Democrat's
health-care overhaul bill would help to reduce the deficit by $143 billion over
the next decade. On the other hand the CBO estimated that the cost of the bill
would come to $940 billion over the next decade.

Included in the CBO figures are both the cost of the Senate bill passed on
Christmas eve last year, and also the package of changes
in the House version of the bill that was released on Thursday.

The cost included $466 billion to give tax credits to help lower earners to
buy insurance, $434 billion to expand the Medicaid insurance program, and $40 billion
in tax credits to help small businesses offer coverage.

The CBO estimated that the Senate bill alone would reduce the federal budget
deficit by $118 billion over a decade compared with the current law. New taxes
and spending cuts will add an additional $25 billion in deficit reduction.

The House change package expands Medicare taxes, so that individuals earning
more than $200,000 a year and families that earn more than $250,000 a year will
pay a 3.8% Medicare tax on unearned income such as dividends and interest. The
latest package also includes $116 billion in cuts over 10 years in subsidies to
Medicare Advantage plans.

(2/7/10)- In a recent report from the Centers for Medicare and Medicaid
Services that was published in the journal Health Affairs it was estimated that
public spending for health care would exceed private spending for the first
time in our history in 2011.

Public funds accounted for 47% of the $2.34 trillion of national health
spending in 2008, the latest year for which that spending is available.

This estimate takes into account that Medicare will not cut Medicare
payments to physicians as called for under the current legal requirements.

The paper estimated that total U.S. health spending hit $2.5 trillion in
2009, up 5.7% from 2008. That figure represents 17.3% of gross domestic
product, up from 16.2% in 2008.

Growth of Medicaid accounts for much of the shift toward publicly funded
health care. The paper predicted enrollment in Medicaid would rise 5.6% this
year and spending would rise 8.9%.

Government spending on health care in the United States accounted for 8.4%
of the GDP in 2009.

Christopher J. Truffer, an actuary at the Centers
for Medicare and Medicaid Services was the main author of the report.

These figures show that whether you are a Republican or a Democrat, were in
favor or against the recent health-care reform bill recently argued in the
Senate, the growing cost for health care in this country will overwhelm us
unless something is done to rein in these costs.

(1/17/10)- Total Medicare spending grew 8.6% in 2008 to $469.2 billion, up
from a rate of 7.1% for 2007. Federal spending for health-care services and
supplies rose by 10.4% in 2008,while spending by
private businesses increased by 1.2% according to the results of a study from
the Department of Health and Human Services.

Micah Hartman, a government statistician who led the work on the study
stated that government spending on health care was equivalent to 36% of federal
receipts, up from 28% in 2007.

In 2008, federal Medicaid spending increased 8.4%, while state spending
decreased by 0.1 percent, the first decline in these expenditures in program
history, according to Mr. Hartman

Spending on Medicare Advantage plans grew by 21% in 2008, to $108 billion.
According to the independent figures gathered by MedPac,
governmental spending for Medicare Advantage plans costs the government 12%
more for Medicare Advantage plans then it spends on regular Medicare plans.

Medicare spending increased 8.6% in 2008 form 2007, to a total of $469
billion, according to the report.

(10/23/09)- It seems as if each health-care benefits
evaluating firm comes up with different numbers in regards to
health-care costs. Hewitt Associates concluded that employees will pay $4,023
in premiums and out-of-pocket charges next year.

In dollar terms, it is the biggest boost since the firm started keeping
track of the data a decade ago.

(9/24/09)- The month of October will mean that another yearly painful period
of making "benefits menu choices" is in store for many employees.

The recently released Kaiser Family Foundation's annual review of health
costs found that 21% of about 3,200 companies surveyed nationally reduced
employee benefits or increased cost sharing, and 15% increased the workers
share of the costs.

The Kaiser study found that some 22% of workers now pay deductibles of more
than $1,000, up from 10% in 2006.

Premiums for employer-sponsored health insurance rose 5% in 2009 to $13,375
for a family, more than double for the $5,791 of 10 years ago. Employees are
paying an average of $3,515 a year in premiums, while their own out-of-pocket
contributions have increased because of higher annual deductibles and
co-payments.

It reinforced the results of a similar study by Mercer LLC, a human resource
data firm, that found that 63% of employers will ask their employees to bear a
greater share of their benefits costs, and 18% of them intend to eliminate the
more generous plans.

(9/17/09)- A new study concluded that Medicare will not save very much under
the policy that it adopted last year of refusing to pay extra costs to treat
hospital-acquired infections and injuries such as bedsores.

Americans acquired about 1.7 million infections while in the hospital, and
99,000 of them die from these infections according to the federal Centers for
Disease Control and Prevention.

Medicare stopped paying the extra costs of treating 10 hospital injuries and
infections beginning n October 2008. The results of
the study were published in a recent edition of the journal Health Affairs.

The study examined data for 767,995 Medicare beneficiaries discharged from
hospitals in 2006, of which it found only 828 cases involved in these
conditions, and only 26 would have been subject to the lower payment rates.

Andrew Blindman, a study author and professor of
medicine and internist at the University of California at San Francisco stated:
"Medicare seems to have a big bark, but the bite seems kind of limited in
many ways."

(8/26/09)- The Centers for Medicare and Medicaid Services (CMS) provides
health insurance to 98 million people, pays 1.2
billion claims a year and has an annual budget of more than $700 billion.

Medicare officials announced that 225 hospitals would divide $12 million in bonuses
that they earned under a pilot pay-for-performance program to help prevent
infections in pneumonia patients and cut death rates in heart-attack patients.
Three poor under performing hospitals will be
penalized under the program.

Premier Inc., a health-information company that is Medicare's contractor on
the project reported that the recipient hospitals saw about 4,700 fewer deaths
among heart attack patients, in the four years ended September 30,2007 than if they had not participated in the program.
There were 30 quality measures taken by these hospitals in which they scored
high enough levels to earn the bonuses.

As an example, Premier said, 92.6% of the pneumonia patients received
antibiotics, flu vaccines or other recommended treatments to prevent acquiring
other infections in the hospital, up from 69.3%.

(6/12/09)- Medical bills caused more than 60% of personal bankruptcies in
the United States in 2007, according to a new study. This was true, even though
over three-quarters of the people who filed for bankruptcy had health insurance
at the beginning of their illness.

The study covered a random national examination of 2,314 bankruptcy filings
in 2007, with the researchers personally interviewing 1,032 of them. The
results of the study will be published in the August edition of the American
Journal of Medicine.

According to SteffieWoolhandler,
one of the study's authors and an associate professor of medicine at Harvard
University, the factors that drove people to bankruptcy included large co-pays,
high prescription drug costs and high deductibles.

The researchers determined that bankruptcy filings linked to health problems
rose by 49.6% between 2001 and 2007.

(3/14/09)- Medicare covers nearly 45 million beneficiaries, including 38
million seniors and 7 million younger adults with permanent disabilities. The
program is expected to cost the federal government approximately $477 billion
in 2009, accounting for 13 percent of federal spending and 19 percent of total
national health expenditures

(3/6/09)- According to the results of a study done by actuaries and
economists at the Centers for Medicare and Medicaid Services,
that was published in a recent edition of the journal Health Affairs,
government spending on health care will increase by 7.4% to $1.191 trillion in
2009.

The country's health-care spending is expected to rise to $2.51 trillion in
2009, up by 5.5% from 2008, when expenditures grew by 6.1%. Private sector
spending is expected to reach $1.319 trillion this year, up from 2008, when
spending in this sector grew 5.4%. Consumer's spending are
expected to grow 1.4% in 2009.

Federal and state governments are expected to spend $386 billion on Medicaid
in 2009, an increase of 9.6% over 2008. The study did not include the effect of
the $787 billion stimulus program which included an additional $87 billion for
Medicaid programs

(2/19/09)- Spending on health care totaled $2.2 trillion, or 16% of the
nation's gross domestic product in 2007, and the Congressional Budget Office
estimates that, without any changes in federal law, it will rise to 25% of
G.D.P. in 2025

(2/13/09)- The Centers for Medicare and Medicaid Services (CMS) has expanded
to four, from one, the number of guides that can be used to determine and
authorize coverage for a drug's use on a particular form of cancer. A judgment
under any one of the guides that a drug is effective is sufficient for
coverage, and the new guides deem more drugs effective for more cancers than
the old guide did.

Last year Medicare spent over $3 billion on cancer drugs, and most private
insurers follow Medicare's decisions on these matters.

In a 2007 study that was conducted by researchers at Tufts and Duke universities, the guide used in the old system supported
only two of the 14 off-label uses of 6 cancer drugs. Now, however, all 14 can
be found in at least one of the four guide books.

Francis Visco, president of the National Breast
Cancer Coalition, a patient-advocacy group, said an independent government
panel should decide coverage. " A lot of these
decisions are being made by associations with conflicts."

One of the four designated guides, published by the National Comprehensive
Cancer Network (NCCN), a group of hospitals, relies on panels of experts to
review drugs, but many of those experts have financial ties to the drug
companies. NCCN also received $230,000 in funding last year from a number of
big drug companies.

The Tufts and Duke researchers commented that Drugdex, another one of the guides often had little support
in the medical field.

(1/21/09)- Health care spending averaged $7,421 for each person in the
United States in 2007, but its growth from 2006 was at the lowest percentage in
nine years. Total health spending rose 6.1%, compared with the 6.7% increase in
2006. The report on government spending for health care was published in a
recent edition of the journal Health Affairs.

Retail spending on prescription drugs rose 4.9% in 2007 to $227.5 billion
compared to the 8.6% increase in 2006 and the 9.4% increase a year from 2001 to
2006. The main author of the report, Micah B. Hartman, a statistician at the
CMS listed 3 reasons for the deceleration of drug spending.

More prescriptions are being filled with generic drugs.
In 2007, 67% of prescriptions were filled with generic drugs, up form 63% in 2006 and 60% in 2005

Drug price increases are increasing more slowly.
Prescription drug prices increased by 1.4% in 2007, compared with the 3.5%
increase in 2006

Safety concerns have affected drug sales. The increased
number of black-box warnings, which were 68 in 2007 compared with 58 in
2006 and 21 in 2003 reflects this.

Prescription drugs accounted for 10% of all health care spending in 2007,
compared to 31% of the total for hospital care and 18% for physicians
bills.

Out-of-pocket spending on health care increased 5.3% in 2007 to $286.6
billion. Federal, state and local governments paid for 46.2% of health-care
spending in 2007, up from45.3% in 2004.

The drug benefit launched by the government in 2006 cost Medicare $40.5
billion in 2006, and $47.6 billion in 2007.

(10/31/08- With states confronting a weakening economy, enrollment in
Medicaid began to rise last year with states expecting even larger increases
for fiscal year 2009, according to a new 50-state survey released today by the
Kaiser Family Foundation's Kaiser Commission on Medicaid and the Uninsured
(KCMU).

With the increased enrollment, Medicaid spending is also rising more rapidly
than in the recent past, raising the potential for program cutbacks as states
confront the combined impact of more enrollees and fewer available resources.

(7/14/08)- From 2000 to 2007, 478,500 claims were filed with Medicare under
the names of 16,500 to 18,2000 dead physicians
according to investigators who reported this information to the Senate Homeland
Security and Government Affairs committee. These scam artists received over
$92.8 million in false payments from Medicare during this period of time.

Herb Kohn, the agency's deputy administrator, said Medicare would soon start
receiving the Social Security Administration's Death Master File, and as of
May, all claims have to be submitted under a new identification system. The
agency has given out two million new numbers to physicians and other providers
with the hope that this will help to end this problem.

Last month, the Government Accountability Office told the panel that 27,000
Medicare doctors, hospitals, hospices and nursing homes failed to pay more than
$2 billion in federal taxes in 2006.

The federal and state governments are the largest third-party payers for
nursing home care. Medicare spent $21 billion on nursing homes in 2007, up from
$17.6 billion in 2005.

According to the CDC National Health Statistics Report dated June 19, 2008,
#1, "In 2004-2006, the majority of persons under age 65 in the United
States had private health insurance coverage (67.8%); a much smaller percentage
were insured through Medicaid or SCHIP (13,2%), and 16.6% were
uninsured."

(4/18/08)- Total U.S. health-care spending rose to about $2.1 trillion in
2006 and hospital care accounted for about $648 billion, or 31% of the total
according to federal figures. More than 90 million Americans have chronic
illnesses like diabetes, cancer and heart disease, and 7 out of 10 die from
chronic diseases. Most of Medicare's spending on such patients in the last two
years of life is for care in hospitals.

An analysis of millions of Medicare records that were studied by researchers
at Dartmouth College showed that the greatest percentage of the cost of the
last two years of life for patients were incurred in the intensive care unit of
the hospitals. It was however the number of visits paid by physicians in this
unit, rather than the number of days of the stay that set the higher cost.

The data was compiled in The Dartmouth Atlas of Health Care. According to
the figures, spending in the last two years of life ranged from an average of
$93,842 for patients who received most of their care at the U.C.L.A Medical
Center to $53,432 at the Mayo Clinic's main teaching hospital in Rochester,
Minn.

Dr. John E. Wennberg of Dartmouth Medical School,
the chief author of the study, said doctors and hospitals that provided more
care, or more intensive care, did not necessarily achieve better results for
patients.

The researchers analyzed data for more than 90 academic medical centers and
focused on five ranked as the nation's best by U.S. New & World Reports

(1/17/08)- Medicare spending increased at its fastest rate in 25 years, but
that number is quite deceiving since it included the cost for Part D drug
spending for the first time. Total spending came to $7,026 a person in 2006 the
latest year for which the data is available, up from $6,649 in 2005 according
to a study from the Centers for Medicare and Medicaid Services.

Health care spending in 2006 exceeded $2.1 trillion, which is the highest
level it has ever been above. Health care spending represented 16% of the gross
domestic product. The results of the study were published in a recent issue of
Health Affairs.

Spending on prescription drugs rose 8.5% in 2006, while generic drugs
accounted for 63% of all drugs dispensed in the U.S. up from 56% in 2005.
Managed care plan spending increased 48% in 2006, which was almost 2 1/2 times
the spending in 2005. This growth represents a 25% increase in enrollment in
this type of plan and increased payments to the insurers.

"The public share of the spending increased from 28% in 2005 to 34% in
2006, while the private share fell from 72% to 66% according to Aaron Catlin
and his co-researchers at the Centers for Medicare and Medicaid Services.

Medicare spending increased to $401.3 billion in 2006 from $338 billion in
2005. Part D spending in 2006 came to $41 billion which was a much lower figure
than analysts had initially estimated when the prescription drug law was passed
in 2003.

Health spending by businesses grew 5.7% in 2006, to $496.8 billion, the
slowest rate of increase since 1997. Retail spending for prescription drugs
shot up by 8.5% in 2006 to $216.7 billion from 2005.

Spending for doctors' services grew 5.9% in 2006, to $447.6 billion, which
was the slowest rate of growth since 1999. Spending on nursing homes grew at
the slowest pace since 1999, rising 3.5% to $124.9 billion.

(11/3/07) The "Survey of Employer Benefits 2007" by the Kaiser
Family Foundation and the Health Research & Educational Trust found that
employer sponsored health insurance premiums increased 6.1% on average in 2007.
Inflation increased 2.6% and workers earnings 3.7%. Interestingly, only 59% of
firms with fewer than 200 workers offer health benefits, down from 68% in 2001.
In these firms, 37% of the employees pay more than half the cost of family plan
premiums and 45% of employers are weighing options that would increase the
amount the employee has to pay for health insurance, while 42% are thinking of
increasing employees' office-visit co-pays or coinsurance.

The majority of covered workers (57%) are enrolled in PPOs, while 21% are in
a HMO. There has been a 1.1 million increase in enrollment in high-deductible
plans in 2007, which now stand at about 3.8 million. Can families who do not
have money in the bank carry such a deductible?

(9/27/07)- A new study, the results of which were published in the Web
edition of the journal of Health Affairs, showed a huge difference in spending
on health care among the states. The highest spending state with an average of
nearly $6,700 was Massachusetts, with Utah averaging the lowest spending of less
than $4,000l per capita.

Trailing Massachusetts, as the highest per capita spenders in 2004 were
Maine, New York, Alaska and Connecticut. The lowest spending states were Utah,
Arizona, Idaho, New Mexico and Nevada. Per capita spending in Utah was 59% of
that in Massachusetts.

Anne B. Martin, an economist at the Centers for Medicare and Medicaid
Services (CMS), who was the lead author of the report, said the reasons for the
differences included the age and incomes of the population, the concentration
of doctors in a state, the generosity of public programs, the extent of private
health insurance coverage and the mix of services used by the state.

In some states with high levels of per capita health spending, the federal
researchers said, people "receive more comprehensive employer-based health
insurance benefit packages."

Experts said that higher per capita spending did not necessarily mean better
care.

(9/15/07)- According to a recent survey, health-care premiums for employers
and their workers continued to soar in 2007. The total annual cost for family
coverage premiums came to $12,106 for the employer and the employee. The survey
that was conducted by the Kaiser Family Foundation and the Health Research and
Educational Trust, queried 3,078 employers, but the results were based on the
1,997 that responded to the full survey.

The average family premium rose 6.1% in 2007, with the employee now paying
on average $3,281 a year for his/her family premium. This is just about double
what the worker paid for this coverage in 2000. In 2006, the premium increase
represented a 7.7% increase over 2005. This rate of increase continues to be
far in excess of the rate of inflation.

Three in four covered employees are in drug plans, with
average-out-of-pocket payments of $11 for generic drugs, $25 for prescription
drugs in the formulary and $43 for brands not on the preferred list.

Ninety-nine percent of companies with more than 200 employees continue to
offer some sort of health-care coverage, while only 59% of smaller businesses
offer their employees health-care coverage. Many of
the larger companies have cut back sharply on the health-care insurance
coverage for new workers in comparison to what is offered to workers who have
been with the company for longer periods of time.

(7/5/07)- Medicare and Medicaid payments for physician's services are
projected to drop 9.9% beginning 11/1/07. This is unlikely to since many
medical professionals feel they would not be adequately compensated for their work.
There has never been a year over year cut in Medicare and Medicaid physician's
services since the inception of these programs. In all prior years, Congress
has always increased the payments for these services. There is no projection at
this point as to approximately how much the increase will be.

Since the Medicare and Medicaid formula requires that these programs
compensate for the lack of the cut, and in fact there will be an increase of
costs, there will have to be an bigger increase of
premiums to the beneficiaries in 2008 than in prior years.

(3/24/07)- The Centers for Medicare and Medicaid Services January 2007
report indicates that the overall health spending ($2 trillion in
2005) hit the lowest growth level since 1999. Health care spending grew
6.9% in 2005, 7.2% in 2004, 8.1% in 2003. However, the
per capita spending for 2005-$6,697 per person- was up from $6,322 in 2004.

Medicare spent 9.5% more on physician services in 2005, a slight decline
from 10.4% in 2004. The total spent was $421 billion, while hospital spending
hit $611 billion.

California has 85,921active doctors, with New York State next with 64,118.
Rounding out the top five are Texas with 44,014, Florida with 42,906 and
Pennsylvania with 34,924. The state with the least amount of active doctors is
Wyoming with 960, next is North Dakota with 1,441, follwed
by Alaska with 1535, South Dakota with 1622 and Vermont with 1,846.

(3/1/07)- Hospital Costs- In these days of soaring health care costs, it
behooves the consumer to know cost estimates for procedures in a hospital. One
of the first states to move in that direction is New Hampshire. The New
Hampshire Dept. of Insurance and Dept. of Health & Human Services have
established a Web site, http://www.nhhealthcost.org
to bring transparency to health costs. Using claims data compiled from health
plans and third-party administrators, the site offers information not only on
medical procedure costs, but also data on how much the consumer would pay-out
of pocket and how much would be covered by their insurance. It is important to
note that the site information is limited to the most common hospital
procedures. The site also doesn't list fees and out-of-pocket costs listed by
individual physicians.

The concern is always about the quality of the data on the Web site.
Statisticians who developed the site attempted to deal with this isue by including a filter that knocks out the highest and
lowest 5% of claims for a particular procedure. The figures you see on the site
represent the median price of a procedure, including physician billings, lab
fees and other costs.

The question one would ask is whether consumers will use this information. A
large majority of consumers rely on physician recommendations for hospital
choice regardless of the price. Combining this information with hospital
procedure ratings would make for a truly informed consumer in control of their
medical treatment. It could eliminate some of the "cost shocks" one
receives after the end of a procedure. Health plans must provide accurate
information and insure transparency so that consumers get the correct
information. It will be up to the state organizations to provide oversight in
this regard.

(2/25/07)- According to a newly released report from the Office of the
Actuary at the federal Centers for Medicare and Medicaid Services the federal
government will pick up about 50% of all health care costs within 10 years,
from the 45% that it picks up now.

John Poisal, who wrote along with several of his
colleagues wrote the report said, "We will continue to face tough
questions about how we finance our health care bill," as out-of-pocket
spending is expected to grow by 22% to $440.8 billion in 2016 from $250 billion
last year.

Medicare spending grew to $418 billion in 2006 from $342 billion in 2005.
The authors of the study concluded that by 2016, 32% of those eligible will be
enrolled in Medicare Advantage plans, up from the 13.5% in 2005.

Federal and state spending on Medicaid last year was estimated at $313.5
billion, which was about the same amount it was in 2005 even though Medicare
provides a drug benefit for low-income Medicaid enrollees.

In the first 7 months of 2006, prescriptions funded by Medicare drug plans
accounted for nearly 9% of medicines bought in retail pharmacies, according to Verispan LLC, a Yardley, Pa. firm that collects data on
health care spending.

The Medicare drug benefit increased the program's share of the nation's
prescription drug spending to 22% last year from 2% in 2005.

The report went on to further conclude that spending on health care will
consume 20% of the nation's gross domestic product, up from its current level
of 16%

(2/10/07)- About one in every four Americans is covered by Medicare and
Medicaid combined. Federal spending for the two programs totaled $554 billion
in 2006,or about 21 % of all federal spending.

The total amount of dollars that is spent on Medicare and Medicaid exceeds
the total amount of dollars that the federal government spends on Social Security.
According to estimates from the CBO, spending on the two health programs are expected to grow at an average of over 7% a year in the
next decade.

For comparative purposes, the Bush administration is seeking a record
military budget of $622 billion for the fiscal 2008 year that begins on October
1, 2007. That sum includes more than $140 billion for war-related costs.

(1/31/07)- President George W. Bush is hoping to put some reins on the
rising cost of Medicare. In doing so, and with other steps that he hopes to be
able to take, the White House expects to show a balanced budget by 20012.

The Congressional Budget Office (CBO) estimates that the Medicare program
cost about $374 billion in 2006. That represents about 14% of all federal
spending. The CBO estimates that it will cost $851 billion by 2017.

(1/19/07)- A report that was issued by the Centers for Medicare and Medicaid
Services showed that health-care spending in 2005 slowed for the third
consecutive year. Aaron Catlin, an economist at the Department of Health and
Human Services, wrote the report.

The study found that the U.S. spent $1,988 trillion or $6,697 per person, on
health care in 2005, the latest year for which data are available. The
government will likely release new data on the issue next month. The study
results were published in the most recent edition of the journal Health
Affairs.

The rise in health care spending of 6.9%, down from 7.2% in 2004 was the
slowest growth rate since 1999. Households spent 6% of personal income on
health care in 2005 compared to 5.4% in 2001.

Home-health care was, by far, the fastest-growing category of health
spending. Spending on home-care rose 11%, to $485 billion in
2005, the third straight year of double-digit growth.

Federal and state governments footed 40% of the bill for health services and
supplies. This represented a 7.8% increase in 2005 as compared to the 7%
increase from the business side of the equation, and 6.2% rise from the
individual household of things.

The increase cost for prescription drugs slowed to 5.8% in 2005, compared to
the 8.6% increase in 2004 and a peak of 18.2% in 1999. Medicaid drug spending
rose 2.8% in 2005 compared with an average annual increase of 15.4% for the
program from 1999 to 2004

The rate of increase for hospitals and doctors grew to $249.4 billion in
2005 compared with $235.8 billion in 2004 One in five
out-of-pocket dollars went to pay for prescription drugs. Hospitals accounted
for 31% of all dollars spent on health care.

Drug manufactures increased prices for band-name prescription drugs an
average of 6% in 2005. This of course does not take into account the fact that
the percentage increase was much greater for the top 50 selling drugs than it
was for the average.

One percent of the population accounted for nearly one-fourth of all health
spending, and 5 % of Americans accounted for nearly one-half of all spending.
42 of the states showed slower growth in Medicaid drug spending in 2005 than in
2004.